THERAPEUTIC TARGET AND CLINICAL IMPACT OF DAY-TO-DAY BLOOD PRESSURE VARIABILITY IN HYPERTENSIVE PATIENTS WITH COVID-19

ABSTRACT

Objectives: Blood pressure variability (BPV) plays an important role in hypertensive patients, and frequently associated with organ damage. Although hypertension is the most common comorbidity in COVID-19, the impact of BPV and therapeutic target of BPV to outcome in COVID-19 patients with hypertension remain unclear. The aim of this study is to investigate the relationship between BPV and severity of COVID-19, in-hospital mortality, hypertensive status,, and efficacy of antihypertensives in suppress hypertensive covid-19 patient's BPV. Design and method: This was a cohort retrospective study that enrolled 351 patients hospitalized with COVID-19. Subjects were classified according to the presence of hypertension, the severity of COVID-19, and BPV status. Mean Arterial Pressure (MAP) was measured at 6 a.m. and 6 p.m. during hospitalization, and BPV was calculated as the coefficient of variation of MAP (MAPCV). MAPCV values above the median were defined as high BPV. We compared the hypertensive status, COVID-19 severity, in-hospital mortality and antihypertensive agents between the BPV groups. Results: The mean age was 53.85 ± 18.84 years-old. Subjects with high BPV were significantly associated with hypertension status (PR = 1.38;95%CI = 1.13- 1.70;p = 0.003) or severe COVID-19 (PR = 1.39;95%CI = 1.09-1.76;p = 0.005). In laboratory findings, high BPV group had higher CRP (55.15 ± 50.80 vs 97.79 ± 77.17), higher creatinine cerum (1.80 ± 3.15 vs 0.91 ± 0.14) and high BPV status also significantly increased risk of mortality (HR = 2.30;95%CI = 1.73-3,86;p = <0.001). Patients with combination of severe COVID-19 status, hypertension (+) and high BPV status had the highest risk of in-hospital mortality (HR = 3.51;95%CI = 2.32-4,97;p < 0.001) compared to other combination status of groups. In COVID-19 patients with hypertension, combination teraphy with CCB as well as CCB monoteraphy significantly decreased BPV (PR = 0.50;95%CI = 0.27-0.93;p = 0.004) and mortality (HR = 0.17;95%CI = 0.05-0.56;p = 0.004). Conclusions: High BPV was associated with hypertensive status and severe COVID-19, and these factors together increased in-hospital mortality. CCB are antihypertensive agents that were potentially effective in suppressing BPV and mortality in COVID-19 patients.